Meso Empowerment Exclusive: Dr. Cameron shares his brilliant insights on breakthrough moments at IMIG Conference in Boston or, Galileo is Smiling

Dr. Robert Cameron
iMig 2012

Dr. Robert Cameron, thoracic surgeon and mesothelioma specialist, was kind enough to provide us with his tweets as he attended the recent IMIG conference in Boston. His “boots on the ground” tweets were simply too compelling to leave alone so we followed up and asked him to elaborate

If you’re reading this, you’re no doubt aware of Dr. Cameron’s pioneering efforts to re-introduce “rationality” to the macho “bigger is better” mentality that unfortunately has tended to dominate meso surgery in the US. Although his pleurectomy/decortication (P/D) model is now becoming not only accepted but strongly endorsed, it wasn’t always this way.

I remember vividly at a meeting among surgeons 12 years ago where his fellow surgeons literally shussed Dr. Cameron when he tried to speak up against powerful, East Coast-driven forces who decreed that their big gnarly “extra-pleural pneumonectomy” (EPP) was as unassailable as a papal decree. For years, Dr. Cameron toiled away, mainly in the dark, while the spotlight remained brightly fixed on the “curative” EPP. But he never lost faith.  Like so many myth busters of lore (Galileo comes to mind), Dr. Cameron’s belief that removing the tumor and sparing the lung was the only rational way.

I can’t speak for Dr. Cameron, but for this cancer warrior, it feels good that his brethren have finally embraced the P/D on which Dr. Cameron based his career and his passion.

Here’s a few of the good doctor’s tweets and the follow up.

Enjoy the read and keep questioning, searching, learning and leaning towards the light.

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IMIG 2012: for the future of treatment of mesothelioma: the future is clearly immunotherapy!

Why is Dr. Cameron so optimistic? Let’s ask.

Dr. Cameron: Although we are only just now learning how to harness the power of immunotherapy, there is already evidence from decades ago that something as simple as stimulation with IL-2 into the pleural space can result in survivals that have rivaled "trimodality therapy" with median survivals as long as 28 months.

Furthermore, the immune system when it does work has been shown in other cancers, such as melanoma and renal cell carcinoma, to eradicate even bulky disease. We are now on a new learning curve with better understanding not only of what it takes to stimulate an immune response but what it takes to reverse the tumor-mediated escape mechanisms present at the actual tumor site. With the accelerated development in this field that has happened over the last few years, we should make good progress in the near future.

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IMIG 2012: Steven Albelda confirms that immunotherapy is a very promising treatment for mesothelioma.

Dr. Steven Albelda
iMig 2012

No need for explantion here. Dr. Cameron’s succinct appraisal speaks for itself. Good news! I remember years ago when I was a director on MARF feeling proud to help sponsor Dr. Abelda’s futuristic benchwork research. Smart guy. Good guy. Glad Dr. A is on the team.

David Sugarbaker: "Can't we all just get along and operate on mesothelioma?"

Funny question, coming from the Pope of the EPP himself who for years dominate the conversation, owned the paradigm, and didn't give much heed to his few naysayers. Let’s face it, we love a title fight between heavyweights, so I couldn’t resist asking Dr. C for his reaction to the EPP’s loudest and most cocksure advocate sudden plea for tolerance. Is Dr. S presuming that surgery, no matter what form it takes, must be bedrock of every treatment regimen for meso?

Dr. Cameron: Despite the continued lack of randomized prospective trials showing exactly what, if any, benefit that surgery offers, Sugarbaker must be feeling the heat of all the mounting data that EPP is not necessary.  In my view, he’s now trying to deflect that argument and avoid controversy by calling on all surgeons regardless of which operation you perform to tell medical oncologists and pulmonologists that surgery forms the cornerstone of treatment.

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IMIG 2012: David Sugarbaker admits that "EPP has no superiority" as an operation over pleurectomy and decortication

Dawgies! Is this one of those “Yes, the earth revolves around the sun” belated acknowledgements? So, Dr. C, why is this such a big deal (picture me feeding the tiger a little red meat).

Dr. Cameron:  “You're kidding right? Most of the posters at this meeting were people trying to do EPPs because they are all under the impression that the "data" shows that it is better.  [Which unfortunately means that for too many ‘get her done’ surgeons with yank-the-lung-it is the earth continues to be the center of the universe….].

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IMIG today: Sugarbaker admitted that he is now doing 2/3 pleurectomies for mesothelioma....a huge change from a few years ago

This is a radical reversal. We asked Dr. C if he knew whether the Titan of Tri-modal had ever publically debunked or disparaged PD for meso?

Dr. Cameron: “I’m not sure he’s ever disparaged the P/D for meso directly but he has said that the only curative operation for the disease was the EPP. “

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Pac Meso Center’s Presentation: "The timing of chemotherapy in the multimodality treatment of malignant pleural mesothelioma" received praise from IMIG.

Congratulations!  To read the abstract of this presentation (by Dr. Cameron), please click here.

Note, it was great to learn that the other surgeon who helped form MARF back in the day (1999), Dr. Harvey Pass, one of the most talented, gifted and intelligent doctors on the planet, complemented the presentation and agreed that chemotherapy may not be such a crucial part of "trimodality" therapy (patient ALWAYS want to avoid chemo; losing their hair, nausea, vomiting, etc.) Thank you Dr. Harvey Pass, one of my heroes in the topsy-turvy turbulent Mesoworld.

Our Presentation: Percutaneous outpatient cryoablation for localized recurrent pleural mesothelioma was likely the highlight of IMIG meeting

This is great news. My law firm is particularly proud of this since cryoablation has been used successfully on several of my meso clients (including Martha Munoz, Patricia Crawford and Sylvia Ramirez) who were relieved and impressed with it’s ease, efficiency and results.

The Pacific Meso Center is currently writing two papers that will be published soon. Consequently, since journals won’t publish anything that’s already been publically circulated, the PMC cannot a this time post it’s powerpoint slides on the internet. Dr. Cameron did however reveal, happily, if not surprisingly, that Dr. Sugarbaker mentioned cryoablation specifically as one of the highlights of info being presented. High praise from the High Priest of Meso! And well should the Big Guy be impressed – preliminary data show that the practice for recurrent patients was effective in 95% of the cases.

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David Sugarbaker TOTALLY BACKS OFF his beloved EPP to "MCR" Macroscopic Complete Resection, which is code for pleurectomy and decortication

We asked Dr. C to flesh out what this means for the typical meso patient. The backstory of course is that Dr. C has always pointed out that total eradication of all tumor is a pipe dream and they only reasonable goal was the removal of all “visible” tumor? (Note to patients – make sure your surgeon is wearing telescopic lens gear).

Dr. Cameron:  Yes, that’s been my common sense approach, but the EPP crowd never embraced this until now. This basically recognizes that what I have said for decades is actually now widely accepted and people like even Dr. Jablons who abandoned P/D for EPP were bowing to peer pressure not acting on data.”

Well, dear readers, hope you enjoyed the ride. It’s been fun. Please drop us a line if you want to learn more. In the meantime, praise hope!

RGW

Sept. 18, 2012

Roger G. Worthington